Battle Cry

Show Me the Medicaid Money

Support for the repeal of Obamacare dropped to 31 percent this week, but right-wing states are still rejecting billions in free money. Buckle up Republicans, Obamacare is here to stay.

Somewhat quietly, Obamacare enrollment hit 4 million this week. Now, it’s certainly true—as critics have noted—that enrollees aren’t the same thing as people who will continue to stay with their plan for a full year. If an enrollee encounters an unexpected expense of replacing a head gasket or something like that, he might skip a payment. But even so, 4 million’s a more-than-respectable number.

Also rather quietly this week, a new tracking poll from the Kaiser Family Foundation showed support for repeal of Obamacare down to 31 percent. As Jay Bookman noted in the Atlanta Journal-Constitution, overall the poll wasn’t something the president would exactly brag about, but it did represent noticeable change, especially among independents, 57 percent of whom now support the law.

That 31 percent number made me sit up straight for one reason. The percent of Americans who identify themselves as conservative is, lately, about 38 percent, says Gallup. So 31 percent is getting down there. And consider this: As of mid-December 2013, the percentage of Americans who favored repeal was 52.3 percent in a Real Clear Politics average of numerous polls. The Affordable Care Act may not be as popular as Twelve Years a Slave, but it’s not The Lone Ranger anymore either.

I would think there’s a direct correlation between these two sets of facts, no? The more people go to the web site and see that they can get insurance at a decent price (in most cases), the more they tell their co-workers and neighbors that doing so wasn’t the horror show they expected. The more people learn about some of the law’s benefits, the more opposition to it softens.

There are still a few more things the American people need to learn about the law, though, and it’s up to the Democrats to tell them, and I’m going to bang on about this until I see some action. As I wrote Wednesday, Governor Rick Perry has said no to $9 billion in free money. Texas is the largest state in the union that hasn’t accepted the Medicaid expansion money, so that’s the biggest figure, but the figures are significant in relation to the population and budget in every single state.

These figures are from a Commonwealth Foundation report from three months ago. Florida is saying no to $9.6 billion, Georgia to $4.9 billion, North Carolina to $5.7 billion. Wisconsin is passing on $1.75 billion, Virginia on $2.15 billion, and Pennsylvania on $5.5 billion (although Pennsylvania is considering the opt-in). And this report’s figure for Texas is actually $9.6 billion.

“It’s going to exist. And inevitably, it’s going to grow. And more and more people are going to get used to it and learn to live with it.”

You know how states clamor for federal highway money? Well, as Commonwealth points out, in every one of these cases, the Medicaid money is more—at least double, typically, and sometimes far more—than what these states get in highway money. And yet they say they don’t want it. They say that over time, they’re going to be on the hook for vast expenditures they can’t afford, or they fret publicly that Washington might change the formula. They’re both bogus arguments.

The federal government is paying 100 percent of states’ expansion costs through 2016 and no less than 90 percent thereafter on a permanent basis. It’s a sweet deal. But okay, what about that (up to) 10 percent that states are going to have to start paying? Ten percent doesn’t sound like a lot, but in dollar terms, isn’t that real money?

The answer is, not really, in most cases. This gets complicated and involves a category of spending by the states for something called “uncompensated care,” which is just what it sounds like—health care provided for free to poor people. State and local governments typically pitch in now on uncompensated care. But as the Center on Budget and Policy Priorities explains in a 2012 report: “The Medicaid expansion will reduce state and local government costs for uncompensated care and other services they provide to the uninsured, which will offset at least some—and in a number of states, possibly all or more than all—of the modest increase in state Medicaid costs.” Overall, the health-care consulting firm The Lewin Group estimates a minimal increase in states’ spending obligations, around 1 or 2 percent, depending on the state.

As for the argument that some GOP governors make that they fear Washington might change the formula...well, that’s straight from Orwell or Kafka. That is: Barack Obama isn’t going to change any formula. President Hillary Clinton wouldn’t be changing any formula. A Democratically controlled Congress won’t be changing any formulas. Only Republican presidents and congresses would do that. In other words, these Republican governors are saying—yeah, the deal looks fine now, but my party might take over, and then I’d be really screwed!

The ACA is here to stay. It’s not going to be struck down. It’s not going to be repealed. That would require a Republican president and 60 GOP senators and a solid GOP House majority, and the odds are strongly against the emergence of such a confluence. It’s going to exist. And inevitably, it’s going to grow. And more and more people are going to get used to it and learn to live with it. And over time, the people in states like Texas and Georgia and Wisconsin are going to see that people in nearby states that took the money are in fact pretty happy with their situations.

It’s only a matter of time before these resistant governors and state legislatures start caving. Democrats have it in their power to help hasten that timetable by making this an issue. They have to have the courage not to wilt or get the vapors whenever a right-winger invokes the evil gummint or the hated Kenyan. Democrats say they’ve waited decades for this moment. Well, it’s here. Now’s not the time to run away from the fight.